The influence of the Covid-19 pandemic on the 90-day mortality rate after emergency surgery for colon cancer

Abstract

The Covid-19 pandemic had a significant impact on the treatment of colon cancer. This was due to the redistribution of doctors and medical resources to empower the treatment of Sars-CoV-2-infected patients. Moreover, the restrictions imposed by the authorities on the general population and hospitals were other key elements that had to be taken into consideration. The surgical activity was massively reduced for both elective and emergency surgeries during the pandemic; initially, the elective ones were postponed. This study aimed to analyze the impact of the Covid-19 pandemic on the 90-day postoperative mortality rate of patients who underwent emergency surgery for colon cancer in the First General Surgery Clinic of Pius Brinzeu County Hospital Timisoara. For conducting this study, data from patients who underwent emergency surgery for colon cancer between 26.02.2020–01.10.2021 and the same period of 2016–2017 and 2018–2019 were collected and analyzed, with a p<0.05 being considered statistically significant. As a result, the 90-days postoperative mortality rate increased to 34.5% during the pandemic. A 22.55% rate was observed during 2016–2017 and an 18.4% rate in 2018–2019. In addition, during the pandemic, correlations w ere identified between the presence of 90-day postoperative mortality and severe symptomatology when presenting to the hospital, stage of the disease, and Charlson comorbidity index. All these aspects influenced the 90-days mortality rate of patients undergoing emergency surgery to treat colon cancer during the pandemic.

Global elective breast- and colorectal cancer surgery performance backlogs, attributable mortality and implemented health system responses during the COVID-19 pandemic: A scoping review

“…Most of the included articles were from high-income countries (HICs) (i.e., n = 38, 76.0% from HICs and n = 12, 24.0% from low-and middle-income countries [LMICs]). Seventeen studies reported on the 'impact of COVID-19' [25, 27, 44, 47, 48, 50-52, 57, 68-73, 75], 30 reported on 'health system responses, effects or challenges' [6, 7, 18, 21-24, 38, 40-43, 45, 46, 49, 53-56, 58-67, 74] and 3 reported on both [5,26,39]. We present the key findings below in a narrative synthesis, according to the primary outcomes (S1 Checklist).…”

“…Five case-series studies, conducted at an institutional level, compared the number of colorectal cancer procedures performed during the pandemic to that performed during preceding years, pre-COVID-19; one of the studies was from an UMIC (China) and four were from HICs (Italy, Romania, Croatia) [39,57,68,70,75]. The relative percentage reduction in the institutional volume of elective colorectal procedures performed ranged from 11.08%-57.3% across these studies [39,57,68,70,75].…”

“…Eleven of the 18 studies that reported on elective surgery activity were undertaken at an institutional level, which limited their statistical power to show a difference [5,26,39,57,[68][69][70][71][72][73]75]. Case performance reductions were not caused solely by elective surgery service suspensions; ancillary pandemic-or patient-specific determinants are tabulated (Table 5).…”

The Consequences of the COVID-19 Pandemic on Emergency Surgery for Colorectal Cancer

“…The literature also supports these ideas, showing an extremely significant difference between the pandemic period and the pre-pandemic period in terms of the number of patients who presented severe symptoms [5]. In addition, some studies show an increase of up to 20.9% in patients who presented severe symptoms [8]. Studies were highlighted showing that the proportion of patients with severe symptoms was significantly higher during the pandemic (p < 0.001) [9].…”

The safety of colorectal cancer surgery during the COVID-19: a systematic review and meta-analysis

“…Of the 15,232 patients, 4,025 underwent CRC surgery during the COVID-19 pandemic (26.4%), and 11,207 underwent CRC surgery before the COVID-19 pandemic (73.6%). Of the 12 studies included in this meta-analysis, two ( 28 , 31 ) were performed in China, two ( 15 , 27 ) in Turkey, two ( 13 , 29 ) in the UK, two ( 32 , 33 ) in Romania, and one each in Austria ( 30 ), Serbia ( 10 ), Italy ( 34 ), and Denmark ( 12 ). The perioperative outcomes of patients in the articles are summarized in Table 2 .…”